** 12th ANNUAL **
2007 Midwest Winefest
Donor Form - Wine Only
a benefit for the Guadalupe Health Foundation - 501 (c) 3
940 S. St. Francis
Wichita, KS 67211
316/264-8794 - phone
316/262-4938 - fax
DONATION DEADLINE:
March 11, 2007
This form allows for 6 donations of differnet wines
Please submit another form if you wish to donate more wines
*
Denotes a required field
Personal Information
*
Name/Business as it should appear in showbook
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Contact Name
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Address
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City/State/Zip
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Phone Number
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Delivery Method
(select one)
Items need to be picked up
Item to be delivered by donor by
Date
(mm/dd/yy)
List Donated Wine 1
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Name of Wine
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Vintage:
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Quantity:
*
Size:
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Fair Market Value:
Lot #:
Inspected:
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Country/Region:
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Appellation:
Producer/Shipper:
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Village/Vineyard (or grape variety):
Rated By:
Points:
List Donated Wine 2
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Name of Wine
*
Vintage:
*
Quantity:
*
Size:
*
Fair Market Value:
Lot #:
Inspected:
*
Country/Region:
*
Appellation:
Producer/Shipper:
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Village/Vineyard (or grape variety):
Rated By:
Points:
List Donated Wine 3
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Name of Wine
*
Vintage:
*
Quantity:
*
Size:
*
Fair Market Value:
Lot #:
Inspected:
*
Country/Region:
*
Appellation:
Producer/Shipper:
*
Village/Vineyard (or grape variety):
Rated By:
Points:
List Donated Wine 4
*
Name of Wine
*
Vintage:
*
Quantity:
*
Size:
*
Fair Market Value:
Lot #:
Inspected:
*
Country/Region:
*
Appellation:
Producer/Shipper:
*
Village/Vineyard (or grape variety):
Rated By:
Points:
List Donated Wine 5
*
Name of Wine
*
Vintage:
*
Quantity:
*
Size:
*
Fair Market Value:
Lot #:
Inspected:
*
Country/Region:
*
Appellation:
Producer/Shipper:
*
Village/Vineyard (or grape variety):
Rated By:
Points:
List Donated Wine 6
*
Name of Wine
*
Vintage:
*
Quantity:
*
Size:
*
Fair Market Value:
Lot #:
Inspected:
*
Country/Region:
*
Appellation:
Producer/Shipper:
*
Village/Vineyard (or grape variety):
Rated By:
Points:
Thank you for your interest in the Midwest Winefest!